Side effects of anti-cancer medications

Abstract

This chapter summarizes some important side effects associated with anti-cancer drugs reported in 2021 and early 2022. DNA-crosslinking agent bendamustine can cause nephrogenic diabetes insipidus; cisplatin can cause thrombosis; cyclophosphamide can cause protein-loss enteritis. Hemorrhagic cystitis can be induced by cyclophosphamide, ifosfamide, and cisplatin, for which hyperbaric oxygen is effective to treat severe cases. Antimetabolite agent capecitabine can cause heart failure; 5-fluorouracil can cause lactic acidosis. Capecitabine can cause severe diarrhea and hand-foot syndrome in patients with partial dihydropyrimidine dehydrogenase (DPD) deficiency, necessitating a 50% reduction of capecitabine dose and DPD testing before initiating capecitabine or 5-fluorouracil. Alarmingly, a single dose of doxorubicin is enough to cause acute heart failure, and bevacizumab plus pertuzumab may cause irreversible heart failure. Bevacizumab can cause anaphylaxis, hypertension, and heart failure, while ramucirumab can cause renal failure and nephrotic syndrome. Notably, the first published cases of azathioprine-related cytomegalovirus-related nephrotic syndrome, overdose-vinblastine-induced Stevens–Johnson syndrome, bevacizumab-induced bilateral adrenal hematoma, imatinib-induced myasthenia gravis, and atezolizumab-induced liver fibrosis were summarized. Tyrosine kinase inhibitor capmatinib can cause interstitial lung disease; ibrutinib can cause atrial fibrillation; lorlatinib can cause hypertriglyceridemia and pancreatitis. Cyclin-dependent kinase 4/6 (CDK 4/6) inhibitor abemaciclib can cause thrombosis. Proteasome inhibitor bortezomib can cause Stevens–Johnson syndrome. Immune checkpoint inhibitor atezolizumab can cause anaphylaxis and encephalitis; nivolumab can cause hypophysitis and type I diabetes. Lastly, different categories of anti-cancer drugs can cause pneumatosis intestinalis leading to bowel perforation and death in severe cases. These studies enhance the awareness of some rare or dangerous side effects of anti-cancer drugs.